The history of artificial disc placements in the entire human spine, and in particular the lumbar spine has been thoroughly reviewed in Applicants' patent application Ser. No. 10/964,633, filed on Oct. 15, 2004 (abandoned Aug. 10, 2007), patent application Ser. No. 11/487,415, filed Jul. 17, 2006 (now U.S. Pat. No. 7,854,766, issued on Dec. 21, 2010), and in Applicants' issued U.S. Pat. No. 7,083,650. In the ‘650 patent, Applicants’ described the surgical posterior unilateral placement of an artificial lumbar disc. Prior to its surgical placement into a disc space, a complete unilateral discectomy (removal of disc material) must be performed to denude the opposing vertebral body endplates to ensure that the spikes of the artificial disc plates can penetrate the vertebral bodies, and that the disc material is freed from the disc space to allow unencumbered disc motion, and prevention of recurrent disc herniations.
During surgical placement of anterior artificial lumbar discs, visualization of the disc space is not a technical problem because the entire diameter and depth of the disc space can be exposed anteriorly with adequate visualization needed to accomplish surgical disc denudement. This is not as easily accomplished through the unilateral posterior discectomy, where visualization is limited to the side of unilateral implantation, and the middle and contralateral disc can not be visualized completely without causing undue retraction of the lumbar nerve root, and even then, full visualization is not adequately achieved.
To remedy this problem, we disclosed in the '650 patent a wired action-ended pituitary rongeur endoscope with centralized illumination emanating between upper and lower pituitary forceps. The advantage of that design was that it could more easily be placed in the small disc space and provide centralized illumination, neither of which is available in another wired action-ended endoscope design described in U.S. Pat. No. 5,667,472 (Finn et al.), “Surgical instrument and method for use with a viewing system”, issued Sep. 16, 1997. In that design the illumination is provided by a tube lateral to the instrument inside the disc space which might endanger the nerve root by over-retraction, and would provide poorer illumination by not focusing on the center of field of vision.
In the present patent application we describe an enhanced design of action-ended endoscopes without encumbrance of wired attachments, and also including a self-contained mounted viewing screen. In totality this design enhances surgical efficiency with respect to operating room time, ergonomics, and financial investment.
To our knowledge, this is the first action-ended endoscope which can function with the complete absence of wires by utilizing a novel induction coil converter converting low voltage power to transient high-powered sparks to initiate gas breakdown of xenon and other molecules, outputting high illumination thereby achieving luminescence equal to wired xenon systems. Another entirely novel aspect of this endoscope is an embodiment which can differentially direct light output in multiple radial and linear directions with digitally controlled reflectors. It can also be easily adapted with lasers to use as a routine laser surgical tool in addition to illumination, forceps grapping, and video display. Furthermore images can be wirelessly transmitted to a mounted self-contained system viewing screen. In addition, it has the capacity to wirelessly transmit images to routine stationary screens, customized work stations, as well as to palm pilots and mobile phones. A further novel application is the ability to manually or electronically control the end manipulator forceps so that it can work as a straight, up or down biter pituitary rongeur combining three types of instruments into one. These modifications with all the above mentioned functions contained within a single action ended-device are entirely unique to endoscopic design to date.
The present invention minimizes operating room clutter associated with routine endoscopic/laser equipment, has a self contained imaging screen, as well as optional therapeutic laser capacities. These functions allow operations to be performed in any sized operating room or military field, thus significantly reducing capital investment, and enhancing surgical and ergonomic efficiency. It also allows surgeries to be performed in places where there might not be any available electrical outlets or electricity or other power sources.
Additional inventions presented here are uniquely related to the design of our lumbar artificial disc design described in application Ser. No. 11/487,415, filed Jul. 17, 2006 (now U.S. Pat. No. 7,854,766, issued on Dec. 21, 2010). These inventions include an instrument which allows easy placement and removal of our lumbar disc ball between upper and lower disc plates, and a disc plate extractor which can extract the device if necessary. There are further modifications of the disc plates including rescue plates with longer spikes, and/or increased plate diameters, akin to rescue screws used for spinal fusion. If a plate falls out under harsh conditions because the spikes are too short, the plate can be rescued with longer/wider spikes or increased width and or ball diameter.
The history of endoscopy, and neuroendoscopy in particular is thoroughly reviewed in “Intracranial endoscopic Neurosurgery”, Editor, David F. Jimenez, The American Association of Neurological Surgeons, 1998.
Recent devices to further enhance endoscopic functions include a device which rotates images using an image sensor to act like a gyroscope or a pair of accelerometers, U.S. Pat. No. 7,037,258, B2, (Chatenever et al.) “Image orientation for endoscopic video displays”, issued May 2, 2006. A remote surgical support system has been described wherein the state of the surgical instrument and the patient data can be checked in remote control rooms, U.S. Pat. No. 6,955,671 B2, (Uchikubo), “Remote Surgery support system”, issued Oct. 18, 2005. Neither of these devices are wireless, or are incorporated into distal action instruments. Neither, do they incorporate any of the advanced technology and wireless transmission of images, or enable differential directional illumination as does our invention.
Another wireless video system entails an in-vivo camera system which is swallowed by the patient, captures and then transmits images of the gastrointestinal tract thereby functioning as an autonomous video endoscope. (See U.S. Pat. No. 6,904,308 B2 (Frisch et al.), “Array system and method for locating an in vivo signal source”, issued Jun. 7, 2005). The patient must wear an antenna array with two antennas. The signals received by the two antennas derive an estimated coordinate set from the signal strength measurements. This innovative device functions specifically as an imaging/camera device. The patient must wear an electrode array to capture the signals over his/her abdomen. It is not designed, nor intended to be a combined surgical tool which performs surgical tool functions e.g. tissue grabbing, suction, cutting etc, which significantly distinguishes it from our invention.
Two more recent patents incorporating wireless technology include U.S. Pat. No. 7,097,615, (Banik et al.), “Robotic endoscope with wireless interface Aug. 29 2006), and U.S. Pat. No. 7,030,904 B2, (Adair et al.), “Reduced area imaging device incorporated within wireless endoscopic devices” Apr. 18 2006. Neither of these patents incorporates action-ended instruments or have a self-contained screen imaging system. Furthermore they are purely used for illumination/video, and they do not exploit our innovative technology of an induction coil thermoelectric converter to enhance wireless xenon light. They do not use controlled directional deflectors to modulate light intensity and direction. They do not have laser surgical tool capacities. They are not capable of wireless transmission to palm pilots, or cell phones.
The inventions described herein have great import not only to anterior and posterior spinal endoscopy, but can be modified and used for diagnostic and therapeutic uses in every endoscopic related field including brain, otolaryngological, pulmonary, gastrointestinal, and urological endoscopy, as well as arthroscopic joint surgery including shoulders, hips, knees, ankles, to name but a few. The multifunctional capacities compressed into a single wireless instrument enabling tissue illumination, tissue manipulation, and therapeutic laser directed treatment with a wireless, self-contained mounted viewing screen would also have profound advantages in the fields of military, emergency, ambulatory, and aerospace medicine in areas and situations where sources of electricity are not guaranteed.